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Audience This policy brief is for policy makers, program managers, researchers, and other professionals dealing with nutrition, health, community development, and social and behaviour change and those with an interest in maternal and child health and development in Kitui County. Purpose There is increasing recognition of the need for implementation research that is designed to provide context-specific information and data to inform decisions for planning nutrition and public health interventions. This brief provides evidence for decisions to improve maternal and young child nutrition derived from a systematic landscape analysis in the county. 1. Introduction : This policy brief summarises key results from conducted in selected communities in the four a study designed to identify potential inter- divisions of Kitui Central (Tiva), Lower Yatta ventions to improve nutrition in infants and (Kalunini), Mutomo (Mwamba), and young children in Kitui County, Kenya. The Mutonguni (Musengo). study was commissioned to provide information necessary for the design of Two research approaches were used in Kitui appropriate high-impact nutrition County: interventions in Kitui to improve nutritional Gretel Pelto and Faith Thuita Faith and Pelto Gretel Kenya Brief Policy outcomes at the household level. • Ethnographic research was conducted using the GAIN-initiated Focused The climate of Kitui County varies between Ethnographic Study of Infant and arid and semi-arid, with very erratic and Young Child Feeding Practices (Pelto unreliable rainfall. Most of the area is hot and Infants and Young Children in Kitui County inand Kitui Young Children Infants and Armar-Klemesu 2014). dry. The limited availability of water, coupled with poor soil fertility, presents major challenges for crop cultivation. More than a • A dietary assessment and an applica- third of the county’s residents reside in the tion of Optifood, a linear programming Feeding marginal mixed farming regions, which rely software tool largely on livestock for food (milk and other products) and revenue. However, the liveli- An FES applies well-established ethnographic hood system is beset by high vulnerability to methods to obtain data from caregivers on recurrent and prolonged droughts, lack of determinants of dietary practices, including water and pasture, high livestock mortality, social, economic, cultural, technological, and and repeated crop failures. The low-lying environmental factors (Pelto et al. 2012). This eastern and central areas of the county are research approach uses sampling procedures also prone to flooding. The study was that ensure representation of economic strata This brief is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID). The contents are the responsibility of GAIN and do not necessarily reflect the views of USAID or the United States Government. 1 and age sub-groups of infants and young use practices for infants and young children, children 6–24 months of age. Optifood is a and associated constraints (Ferguson et al. research tool that uses data obtained from 2006). These two approaches combined are dietary intake measurement to reveal the used to identify context-specific opportunities strengths and weaknesses of current diets. It and limitations for dietary improvement identifies locally appropriate food-based through behaviour change interventions (Hotz modifications to improve dietary adequacy, et al. 2015). taking into account local dietary norms, food 2. Overview of the Situation: The Importance of Nutrition in Infancy and Early Childhood Adequate nutrition is essential to growth, complementary feeding from 6 months health, and development during infancy and through at least 2 years, and continued early childhood. Under-nutrition, which in breastfeeding to 2 years of age or beyond. addition to being the result of inadequate Appropriate complementary feeding includes diets, is also influenced by hygienic practices, timely initiation of solid/ semi-solid foods health provision, and care, is an underlying from 6 months of age; increasing the amount, factor in 45% of child deaths (Black et al. density, and variety of foods; increasing the 2013). The immediate consequences of poor frequency of feeding as the child gets older; : nutrition during the early formative years responsively feeding the child; and ensuring include significant morbidity, mortality, and that good hygiene practices are used in delayed mental and motor development. In preparation and feeding, while maintaining the long term, early nutritional deficits are breastfeeding. linked to impairment in intellectual performance, decreased work capacity, and IYCF practices in Kenya are currently less poorer reproductive outcomes and overall than optimal. Only 25% of young children are health during adolescence and adulthood. The fed adequately diverse diets (Kothari and ‘1,000-day window’—the period from Abderrahim 2010). In previous research, care- Gretel Pelto and Faith Thuita Faith and Pelto Gretel givers, families, and communities in Kenya Kenya Brief Policy conception to a child’s second birthday—is a critical time frame for the promotion of have been reported to lack up-to-date knowl- optimal growth, health, and behavioural edge of optimal IYCF practices, particularly development (World Health Organisation during the complementary feeding period (Thuita 2008; Nduati et al. 2008; Israel- Infants and Young Children in Kitui County inand Kitui Young Children Infants [WHO] 2010). Ballard et al. 2009). Improving IYCF practices are a major determinant of complementary feeding practices amongst child nutritional status outcomes. Optimal Kenyan children aged 6–23 months could IYCF practices include exclusive breastfeed- significantly contribute to improved child Feeding ing for the first 6 months and appropriate survival, health, and development. 3. Overview of Methods To assess current practices and identify poten- interviews. The modules are designed to tial interventions to improve nutrition in explore a range of issues, including foods for infants and young children, researchers used infants and young children, food preparation the FES manual and protocols (Pelto and and feeding practices, sources of food Armar-Klemesu 2014). Each protocol acquisition and food expenditures, types of consists of a set of modules, which are problems faced by parents of infants and administered through in-depth one-on-one young children, food and nutrition problems 2 of infants and young children, perceptions probing to expand and interpret the initial about health and food, and perceptions about responses. The nutritional assessment of IYC micronutrient supplements and fortification of diets was done via a cross-sectional dietary infant foods. The modules’ open-ended survey and analysis using Optifood software questions were administered with extensive (Ferguson et al. 2015). 4. Results Infant and young child diets estimated breastmilk intakes (Ferguson et al. 2015). In Kitui, breastfeeding rates from 6-23 months are high. All mothers reported that the Increased frequency of feeding specific, index child was initially breastfed and all but locally available foods could go a long way in 2 of the 32 children aged 6–23 months were filling nutrient gaps in the IYC diet. This breastfed at the time of the study. However, includes consumption of animal milk three analysis of the current diets of infants and times a day every day (added to porridges so young children showed that they are as not to encourage displacement of breast inadequate in many nutrients. milk); green leafy vegetables, millet, and a fortified cereal once a day every day; legumes The majority of children consumed porridges one or two times a day every day; and meat, (based primarily on unrefined maize flour and fish, or eggs three times per week. : secondarily on the preferred grains, i.e. millet and sorghum). The most common accompani- While incorporating these changes into ment to these staples was the broth from current diets would allow infants and young vegetable stews. Milk, as a separate beverage, children to meet their requirements for nine was consumed by many children, but tended nutrients (6–11 months) or seven nutrients to decrease in the second year of life. Few (12–23 months), after accounting for children consumed animal flesh foods (0%– estimated breastmilk intakes, adequate intakes 2%) or fresh fruits (8%–9%). of iron, zinc, and calcium would be difficult to achieve, and additional solutions are Gretel Pelto and Faith Thuita Faith and Pelto Gretel The limited number of foods commonly Kenya Brief Policy required to increase access to good food consumed by children in Kitui was reflected sources of these nutrients beyond current food in low dietary diversity scores, which is a use and dietary patterns (Ferguson et al. general measure of the quality of the diet. 2015). Fewer than 25% of children achieved the Infants and Young Children in Kitui County inand Kitui Young Children Infants minimum dietary diversity of 4 food groups Food acquisition for infants and or more for children 6-23 months of age young children (WHO 2008). The nutrient density in the infant and young child (IYC) diet, another The results indicate that not only do Feeding measure of dietary quality, was often low. caregivers generally access foods through The nutrient densities of diets of children 6–8 markets, but several food items used months old were below WHO desired levels specifically in IYC diets are obtained for 8 of 10 key nutrients examined (the primarily from markets. None of the families exceptions being vitamin A and vitamin C). in the study produced all of the foods that For the age sub-groups in the 9–23 month they needed to feed themselves and their range, nutrient densities were below desired children. The amount of time that they could levels for 7 of the 10 key nutrients. The most rely on home-produced staple foods varied, serious problem nutrients were iron and zinc but was never more than a few months at in all age groups and vitamin B12 in the 12– best. 23 month age group, after accounting for 3 The preferred grain for infant porridge is because women have no choice.

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